A Pilot Standardized Simulation-Based Mechanical Ventilation Curriculum Targeting Pulmonary and Critical Care Medicine and Critical Care Medicine Fellows

Abstract

Introduction The mastery of mechanical ventilation (MV) management is challenging, as it requires the integration of physiological and technological knowledge with critical thinking. Our aim was to create a standardized curriculum with assessment tools based on evidence-based practices to identify the skill deficit and improve knowledge in MV management.

Methods For 3 years, 3 hours of standardized curriculum for each first-year pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellows was integrated into the orientation (chronologically): (1) a baseline knowledge pretest; (2) a 1-hour one-on-one case-based simulation session with debriefing. A 34-item competency checklist was used to assess critically thinking and skills and guide the debriefing; (3) a 1-hour group didactic on respiratory mechanics and physiology; (4) a 45-minute hands-on session in small groups of one to three fellows for basic knobology, waveforms, and various modes of mechanical ventilators; (5) a 15-minute group bedside teaching of vented patients covering topics such as techniques to alleviate dyssynchrony and advanced ventilator modes; (6) a one-on-one simulation reassessment session; (7) a knowledge posttest. Fellows' performances at baseline, 1-month posttest, and end-of-first year post-test were compared.

Results Fellows (n = 24) demonstrated significant improvement at 1-month posttest in knowledge (54.2% ± 11.0 vs. 76.6 ± 11.7%, p < 0.001) and MV competency (40.7 ± 11.0% vs. 69.7 ± 9.3%, p < 0.001), compared with pretest. These improvements were retained at the end-of-year reassessments (knowledge 75.1 ± 14.5% and MV competency 85.5 ± 8.7%; p < 0.001).

Conclusion Standardized simulation-based MV curriculum may improve the medical knowledge competency, and confidence of first-year PCCM and CCM fellows toward MV management before encountering actual ventilated patients.

Keywords

simulation - mechanical ventilation - fellowship - competency

Publication History

Article published online:
03 October 2023

• References

• 1 Dorman T, Angood PB, Angus DC. et al; American College of Critical Care Medicine. Guidelines for critical care medicine training and continuing medical education. Crit Care Med 2004; 32 (01) 263-272
• 2 Wax RS, Kenny L, Burns P. Educating providers of mechanical ventilation: an update. Curr Opin Crit Care 2006; 12 (01) 61-66
• 3 Ramar K, De Moraes AG, Selim B, Holets S, Oeckler R. Effectiveness of hands-on tutoring and guided self-directed learning versus self-directed learning alone to educate critical care fellows on mechanical ventilation - a pilot project. Med Educ Online 2016; 21: 32727
• 4 Tallo FS, Vendrame LS, Baitello AL. Comparison of three methods for teaching mechanical ventilation in an emergency setting to sixth-year medical students: a randomized trial. Rev Assoc Med Bras 2020; 66 (10) 1409-1413
• 5 Keller JM, Claar D, Ferreira JC. et al. Mechanical ventilation training during graduate medical education: perspectives and review of the literature. J Grad Med Educ 2019; 11 (04) 389-401
• 6 Weiss CH, Baker DW, Weiner S. et al. Low tidal volume ventilation use in acute respiratory distress syndrome. Crit Care Med 2016; 44 (08) 1515-1522
• 7 Marini JJ. Mechanical ventilation: past lessons and the near future. Crit Care 2013; 17 (Suppl 1, Suppl 1): S1
• 8 Cox CE, Carson SS, Ely EW. et al. Effectiveness of medical resident education in mechanical ventilation. Am J Respir Crit Care Med 2003; 167 (01) 32-38
• 9 Hayes MM, Chatterjee S, Schwartzstein RM. Critical thinking in critical care: five strategies to improve teaching and learning in the intensive care unit. Ann Am Thorac Soc 2017; 14 (04) 569-575
• 10 Kluen LM, Nixon P, Agorastos A, Wiedemann K, Schwabe L. Impact of stress and glucocorticoids on schema-based learning. Neuropsychopharmacology 2017; 42 (06) 1254-1261
• 11 Santamaria JD, Tobin AE, Reid DA. Do we practise low tidal-volume ventilation in the intensive care unit? a 14-year audit. Crit Care Resusc 2015; 17 (02) 108-112
• 12 Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. The Cochrane Effective Practice and Organization of Care Review Group. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998; 317 (7156) 465-468
• 13 Schroedl CJ, Corbridge TC, Cohen ER. et al. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial. J Crit Care 2012; 27 (02) 219.e7-219.e13
• 14 Keegan RD, Brown GR, Gordon A. Use of a simulation of the ventilator-patient interaction as an active learning exercise: comparison with traditional lecture. J Vet Med Educ 2012; 39 (04) 359-367
• 15 Singer BD, Corbridge TC, Schroedl CJ. et al. First-year residents outperform third-year residents after simulation-based education in critical care medicine. Simul Healthc 2013; 8 (02) 67-71
• 16 Euliano TY. Teaching respiratory physiology: clinical correlation with a human patient simulator. J Clin Monit Comput 2000; 16 (5-6): 465-470
• 17 Spadaro S, Karbing DS, Fogagnolo A. et al. Simulation training for residents focused on mechanical ventilation: a randomized trial using mannequin-based versus computer-based simulation. Simul Healthc 2017; 12 (06) 349-355
• 18 Havaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation training in hemodynamic monitoring and mechanical ventilation: an assessment of physician's performance. Indian J Crit Care Med 2020; 24 (06) 423-428
• 19 Alchakaki A. et al. A novel simulation-based mastery curriculum for mechanical ventilation (MV) in pulmonary & critical care training programs; C40. Innovative Medical Education Research and Training Programs. American Thoracic Society International Conference Abstracts. American Thoracic Society; 2018: A4912-A4912 DOI: 10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A4912
• 20 Schroedl CJ, Frogameni A, Barsuk JH, Cohen ER, Sivarajan L, Wayne DB. Impact of simulation-based mastery learning on resident skill managing mechanical ventilators. ATS Sch 2020; 2 (01) 34-48
• 21 Colombo D, Cammarota G, Alemani M. et al. Efficacy of ventilator waveforms observation in detecting patient-ventilator asynchrony. Crit Care Med 2011; 39 (11) 2452-2457